By Statute, Mowing Is Only Permitable During the Month of August
BY STATUTE, MOWING IS ONLY PERMITABLE DURING THE MONTH OF AUGUST
Form1750 (1-26-19)MINNESOTADEPARTMENTOFTRANSPORTATION MOWING/HAYINGPERMITAPPLICATION / Document Management System # ______
District ______Permit # ______
C.S. ______T.H. ______
R.P. ______
(THIS SECTION FOR MnDOT OFFICE USE ONLY.)
ATTACHASKETCHOFTHEPROPOSED WORKAREAAND RELATION TO TRUNKHIGHWAY.
SUBMITTO DISTRICTOFFICEOFMINNESOTA DEPARTMENTOFTRANSPORTATION.
APPLICANT / TELEPHONE / ADDRESS (Street,City, State,Zip)
IS THE APPLICANT THE OWNER OR OCCUPANT OF THE ABUTTING LAND? Yes No
LOCATION OF PROPOSED WORK(City/Township) (County) (Distance) (N-S-E-W) SPECIFIC ROAD INTERSECTION OR LANDMARK
Highway in , Miles of
ISTHISWITHINTRIBALLANDS? IF YES,A PERMIT TO MOW/HAY CAN NOT BE ISSUED
APPLICANT'SACCEPTANCE,WAIVER AND INDEMNIFICATION
Theundersignedapplicantherebyagrees tocomplywith applicable statutes,rules andallofthe standard conditions andspecialprovisionsofthis permit.The applicant understands andagrees thatnoworkin connectionwiththis applicationwillbe starteduntiltheapplicationhasbeen approvedandthe permitissued.
The applicantis aware ofcircumstances,dangersor hazards thatmayarise whileworkingonahighwayrightofwaythatcouldresultininjury, loss,damage or death,andtheapplicant assumes the risk ofsuch circumstances, dangers orhazards,whether reasonablyforeseeableor not.The applicantis also aware that vegetation alonghighwayroadsidesmaycontain residue fromautomotive emissions andchemicalherbicides usedfor vegetative control.
The applicantexpresslyagreesthatexceptfor negligentacts ofthe State,its agents andemployees,theapplicantshallassumeallliabilityfor,and save the State,its agents andemployees, harmless from, anyandallclaims for damages,actionsor causesofactionarisingoutofthe worktobe donebythe applicantorontheapplicant'sbehalfinconnectionwiththis applicationandpermit.
The applicantagrees to restore the trunkhighwayrightofwaytoits originalcondition orothersatisfactorycondition.The applicant accepts responsibilityfor repair of anydamage tothe trunkhighwayrightofwaycausedbymowing/hayingoperations,includingbutnotlimitedtorutting ofditches,cuttingof designatedlandscape plantings,or damage tosurveymonuments.
NAMEAND TITLE / EMAILADDRESS
DATE / SIGNATURE
DO NOTWRITE BELOW THISLINE
PERMIT NOTVALID UNLESS BEARINGAUTHORIZED DISTRICTSIGNATUREAND NUMBER
AUTHORIZATION OFPERMIT
In considerationoftheapplicant’sagreement tocomply inallrespectswith theapplicable lawsand theconditionsofthe Commissioner ofTransportation pertaining tothispermit,permissionisherebygrantedfortheworktobeperformed asdescribed intheaboveapplication,saidworktobeperformed inaccordance with the following:
SEEATTACHED STANDARD CONDITIONS AND SPECIALPROVISIONS
YOU MUSTCONTACTTHEMnDOT AUTHORIZED REPRESENTATIVE PRIOR TOCUTTING:
Contact NamePhoneNumber
DateAll WorkTo BeCompletedBy / AuthorizedMnDOT Signature / Date of AuthorizedSignature
DISTRIBUTION
Original to Area Maintenance Engineer
Applicant
Subarea Supervisor
Roadway Regulations Supervisor / DEPOSIT REQUIREMENTS
No Deposit Required ______
Deposit Required in the Amount of $ ______
Date Deposit Received ______
Deposit to be returned upon satisfactory completion of all work / DEPOSIT TYPE
Cashier's Check # ______
Certified Check # ______
Money Order # ______
Bond # ______
DATEWORKCOMPLETEDThe datewhenthework is completedmust bereported to theMnDOTDistrictPermitsOffice)